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Without prompt medical attention and often expedient emergency surgery, earthquake
victims having blunt torso trauma will experience increased mortality [
]. Rapid identification of necessary emergent medical vs surgical interventions is
critically important. Accurate triage is a necessity, particularly with limited medical
resources in the chaos after a mass casualty event. The Simple Triage and Rapid Treatment
(START) triage method [
] sorts patients into 4 colored tag categories, dependent upon respiratory rate, perfusion
(presence of radial pulse and capillary refill time), and mental status (response
to commands): red (critically ill patients requiring immediate medical care), yellow
(patients in urgent condition, which may receive delayed medical care), green (patients
having minor injuries), and black (patients deceased or expectantly soon to be deceased)
(Fig. 1). The START method typically requires 3 minutes to complete per patient after an
earthquake [
Based on respiratory rate, perfusion (radial pulse presence and capillary refill time),
and mental status (ability to obey command), the START procedure sorts patients into
4 triage categories, which include (1) Red tag: Victim requires immediate intervention
and transport. Medical attention is required within (60) minutes for survival; (2)
Yellow tag: Victim’s transport may be delayed. Serious and potentially life-threatening
injuries are included in this strata, but patient status is not expected to deteriorate
significantly over several hours; (3) Green tag: Victim had relatively minor injuries
and may be able to assist in his/her own care. A proportion will require additional
secondary triage; (4) Black tag: Victim is unlikely to survive given severity of injuries,
level of available care, or both. Palliative care and pain relief should be provided.
